Indagini e ipotesi di consolidamento statico della chiesa di S.Nicola in Pisa

Il presente lavoro di tesi si prefigge come obiettivi: - l’analisi delle modalità di risposta strutturale della chiesa di S.Nicola in Pisa, in caso di eventuali fenomeni sismici - la formulazione di ipotesi di consolidamento strutturale. Coerentemente agli scopi sopraccitati, lo studio si articola in cinque fasi: - indagine storica, volta ad individuare le diverse fasi costruttive che hanno interessato l’edificio in questione ed i danni ad esso arrecati da eventuali fenomeni sismici verificatisi in passato. - Redazione degli elaborati di rilievo geometrico della chiesa e descrizione delle caratteristiche geometriche e meccaniche delle strutture della “ fabbrica”. - Descrizione dello stato di dissesto della chiesa. - Analisi dinamica agli elementi finiti con programma strutturale “Cosmos”. - Intervento di consolidamento delle volte realizzato con i materiali compositi (FRP)

Therapeutic itineraries and explanations for tuberculosis: an indigenous perspective

ABSTRACT OBJECTIVE To analyze explanations for tuberculosis and therapeutic itineraries of Brazilian indigenous people. METHODS Case study with a qualitative-descriptive approach. We conducted semi-structured interviews with 11 Munduruku indigenous, including direct observation of treatment for tuberculosis in the municipality of Jacareacanga, south-western region of the state of Para, Brazil. To identify explanations for tuberculosis and therapeutic itineraries, we performed thematic content analysis. RESULTS Traditional medicine was the first therapeutic option chosen by the indigenous. However, biomedicine was also employed, which indicates a circulation between different therapeutic contexts and health concepts among the Munduruku. The explanations provided ranged from recognition of the signs and symptoms specific to tuberculosis to the attribution of the disease to a spirit that leaves the body and wanders in the woods, returning ill into the body. Unlike the biomedical model, which links tuberculosis transmission strictly to interpersonal contact, in closed spaces without natural lighting and ventilation (preferably domestic environments), the Munduruku associate the disease to an indirect contact between people socially distant (enemies or adversaries) in public and open places. CONCLUSIONS The explanations made by the indigenous are unique and deserve the attention of those who are responsible for developing health public policies, as well as of the teams who work on the villages. To guarantee an efficient control of tuberculosis in these regions, it is necessary that the developed actions integrate biomedicine knowledge and the traditional medicine of the indigenous people, in addition to respecting and welcoming local culture manifestations.RESUMO OBJETIVO Analisar explicações sobre adoecimento por tuberculose e itinerários terapêuticos de indígenas brasileiros. MÉTODOS Estudo de caso, com abordagem quali-descritiva. Foram realizadas entrevistas semiestruturadas com 11 indígenas Munduruku, incluindo observação direta do tratamento da tuberculose no município de Jacareacanga, região sudoeste do estado do Pará, em 2010. A fim de identificar explicações para tuberculose e itinerários terapêuticos, realizou-se análise de conteúdo temático. RESULTADOS A medicina tradicional foi o itinerário terapêutico inicial escolhido pelos indígenas. Entretanto, a biomedicina também foi utilizada, indicando haver circulação entre diferentes contextos terapêuticos e concepções de saúde entre os indígenas Munduruku. As explicações variaram do reconhecimento de sinais e sintomas específicos da tuberculose até o relato de que o espírito sai do corpo, vagando pela floresta e que, quando retorna para o corpo, traz consigo a doença. Ao contrário do modelo biomédico, que vincula a transmissão da tuberculose exclusivamente ao contato interpessoal, em espaços fechados, sem luz natural e sem ventilação (preferencialmente em ambientes domésticos), a perspectiva Munduruku associa a doença ao contato indireto entre pessoas socialmente distantes (inimigos ou adversários) em locais públicos e abertos. CONCLUSÕES As explicações formuladas pelos indígenas são singulares e merecem a atenção dos formuladores de políticas de saúde, assim como das equipes que atuam nas aldeias. Para garantir controle eficaz da tuberculose nessas localidades, é necessário que as ações desenvolvidas integrem conhecimentos da biomedicina e da medicina tradicional indígena, além de respeitar e acolher as manifestações da cultura local

Formación profesional en trabajo social en el actual contexto latinoamericano. Políticas, instituciones y sujetos

El propósito de este artículo es presentar algunos resultados de una línea de investigación que sostenemos desde el 2012, parte del Programa de Estudios sobre Fundamentos Teórico-Metodológicos del Trabajo Social (PEFTS), del Departamento de Ciencias Sociales de la Universidad Nacional de Luján, República Argentina. El tema vincula las transformaciones que se produjeron a partir de la influencia de las políticas neoliberales sobre las formaciones estatales y sus instituciones en países de América Latina, en particular para las Universidades. Para la región, esto trajo consecuencias en las relaciones Estado-Sociedad Civil, lo que impactó en la configuración de, por ejemplo, las políticas de Educación Superior, lo que repercute sobre el proceso de formación profesional en Trabajo Social. A través del estudio de ponencias presentadas en los últimos dos Seminarios Latinoamericanos de la Asociación Latinoamericana de Enseñanza e Investigación en Trabajo Social (ALAEITS) —año 2012 en Córdoba, Argentina, y año 2015 en Mazatlán, México—, es que abordamos estos temas poniendo especial atención a la dimensión ético-política en la formación y el ejercicio profesionales

Personalized screening and risk profiles for Mild Cognitive Impairment via a Machine Learning Framework: Implications for general practice.

peer reviewedOBJECTIVES: Diagnosis of Mild Cognitive Impairment (MCI) requires lengthy diagnostic procedures, typically available at tertiary Health Care Centers (HCC). This prospective study evaluated a flexible Machine Learning (ML) framework toward identifying persons with MCI or dementia based on information that can be readily available in a primary HC setting. METHODS: Demographic and clinical data, informant ratings of recent behavioral changes, self-reported anxiety and depression symptoms, subjective cognitive complaints, and Mini Mental State Examination (MMSE) scores were pooled from two aging cohorts from the island of Crete, Greece (N = 763 aged 60-93 years) comprising persons diagnosed with MCI (n = 277) or dementia (n = 153), and cognitively non-impaired persons (CNI, n = 333). A Balanced Random Forest Classifier was used for classification and variable importance-based feature selection in nested cross-validation schemes (CNI vs MCI, CNI vs Dementia, MCI vs Dementia). Global-level model-agnostic analyses identified predictors displaying nonlinear behavior. Local level agnostic analyses pinpointed key predictor variables for a given classification result after statistically controlling for all other predictors in the model. RESULTS: Classification of MCI vs CNI was achieved with improved sensitivity (74 %) and comparable specificity (73 %) compared to MMSE alone (37.2 % and 94.3 %, respectively). Additional high-ranking features included age, education, behavioral changes, multicomorbidity and polypharmacy. Higher classification accuracy was achieved for MCI vs Dementia (sensitivity/specificity = 87 %) and CNI vs Dementia (sensitivity/specificity = 94 %) using the same set of variables. Model agnostic analyses revealed notable individual variability in the contribution of specific variables toward a given classification result. CONCLUSIONS: Improved capacity to identify elderly with MCI can be achieved by combining demographic and medical information readily available at the PHC setting with MMSE scores, and informant ratings of behavioral changes. Explainability at the patient level may help clinicians identify specific predictor variables and patient scores to a given prediction outcome toward personalized risk assessment

Higher Tetanus Toxoid Immunity 2 Years After PsA-TT Introduction in Mali.

BACKGROUND: In 2010, mass vaccination with a then-new meningococcal A polysaccharide-tetanus toxoid protein conjugate vaccine (PsA-TT, or MenAfriVac) was undertaken in 1- to 29-year-olds in Bamako, Mali. Whether vaccination with PsA-TT effectively boosts tetanus immunity in a population with heterogeneous baseline tetanus immunity is not known. We assessed the impact of PsA-TT on tetanus toxoid (TT) immunity by quantifying age- and sex-specific immunity prior to and 2 years after introduction. METHODS: Using a household-based, age-stratified design, we randomly selected participants for a prevaccination serological survey in 2010 and a postvaccination survey in 2012. TT immunoglobulin G (IgG) antibodies were quantified and geometric mean concentrations (GMCs) pre- and postvaccination among all age groups targeted for vaccination were compared. The probability of TT IgG levels ≥0.1 IU/mL (indicating short-term protection) and ≥1.0 IU/mL (indicating long-term protection) by age and sex was determined using logistic regression models. RESULTS: Analysis of 793 prevaccination and 800 postvaccination sera indicated that while GMCs were low pre-PsA-TT, significantly higher GMCs in all age-sex strata were observed 2 years after PsA-TT introduction. The percentage with short-term immunity increased from 57.1% to 88.4% (31.3-point increase; 95% confidence interval [CI], 26.6-36.0;, P < .0001) and with long-term immunity increased from 20.0% to 58.5% (38.5-point increase; 95% CI, 33.7-43.3; P < .0001) pre- and postvaccination. CONCLUSIONS: Significantly higher TT immunity was observed among vaccine-targeted age groups up to 2 years after Mali's PsA-TT mass vaccination campaign. Our results, combined with evidence from clinical trials, strongly suggest that conjugate vaccines containing TT such as PsA-TT should be considered bivalent vaccines because of their ability to boost tetanus immunity

MODELO PREDICTIVO DE DETERMINANTES SOCIOECONÓMICOS PARA TUBERCULOSIS EN POBLACIÓN INDÍGENA DEL ESTADO DE PARÁ, BRASIL

Objetivo: desenvolver um modelo capaz de identificar a correlação entre determinantessocioeconômicos e incidência de tuberculose na população indígena do estado do Pará.Método: estudo analítico e quantitativo, no qual se construiu um modelo preditivo por meio deregressão de Poisson para 285 casos novos notificados no Sistema de Informação de Agravo eNotificação, no período de janeiro de 2010 a dezembro de 2015, no Estado do Pará.Resultados: partindo do modelo construído, pode-se confirmar que 86% do total de novos casosde tuberculose pode ser explicada pelas variáveis: recebimento de benefício social do governo,renda, escolaridade e sexo. A primeira variável foi considerada a mais significativa com nível dep<0.10.Conclusão: o modelo preditivo é útil como suporte para tomada de decisão, pois permite direcionarações de controle da tuberculose aos indivíduos sob maior risco: indígenas do sexo masculino, semescolaridade e que não recebem benefícios sociais.Objetivo: Desarrollar un modelo capaz de identificar la correlación entre determinantessocioeconómicos e incidencia de tuberculosis en la población indígena del estado de Pará.Método: Estudio analítico, cuantitativo, en el que se construyó un modelo predictivo medianteregresión de Poisson para 285 casos nuevos reportados al Sistema de Informação de Agravoe Notificação entre enero de 2010 y diciembre de 2015 en el estado de Pará.Resultados: Partiendo del modelo construido, puede confirmarse que el 86% del total denuevos casos de tuberculosis encuentra explicación mediante las variables: recepción debeneficio social gubernamental, ingresos, escolarización y sexo. La primera variable fueconsiderada la más significativa, con nivel p<0,10.Conclusión: El modelo predictivo es útil como soporte a la toma de decisiones, permitiendoorientar acciones de control de la tuberculosis hacia los individuos bajo mayores riesgos:indígenas de sexo masculino, sin escolarización, que no reciben beneficios sociales.Objective: develop a model that is able to identify the correlation between socioeconomicdeterminants and incidence of tuberculosis in the indigenous population of the state of Pará.Method: quantitative analytical study, which built a predictive model using Poisson regressionfor 285 new cases reported in the Notifiable Diseases Information System, from January 2010to December 2015, in the state of Pará.Results: the model confirmed that 86% of the total number of new cases can be explained bythe variables: receipt of social benefits from the government, income, education and sex. Thefirst variable was considered the most significant with p<0.10.Conclusion: the predictive model is useful as a support for making decisions, since it enablesfocusing tuberculosis control actions on individuals at greater risk: indigenous men, with noeducation, who do not receive social benefits

A family-based study of gene variants and maternal folate and choline in neuroblastoma: a report from the Children’s Oncology Group

Neuroblastoma is a childhood cancer of the sympathetic nervous system with embryonic origins. Previous epidemiologic studies suggest maternal vitamin supplementation during pregnancy reduces the risk of neuroblastoma. We hypothesized offspring and maternal genetic variants in folate-related and choline-related genes are associated with neuroblastoma and modify the effects of maternal intake of folate, choline and folic acid

Under-reporting of COVID-19 cases among indigenous peoples in Brazil : a new expression of old inequalities

Objective: To estimate the incidence, mortality and lethality rates of COVID-19 among Indigenous Peoples in the Brazilian Amazon. Additionally, to analyze how external threats can contribute to spread the disease in Indigenous Lands (IL). Methods: The Brazilian Amazon is home to nearly half a million Indigenous persons, representing more than 170 ethnic groups. As a pioneer in heading Indigenous community-based surveillance (I-CBS) in Brazil, the Coordination of the Indigenous Organizations of the Brazilian Amazon (COIAB) started to monitor Indigenous COVID-19 cases in March of 2020. Brazil's Ministry of Health (MOH) was the main source of data regarding non-Indigenous cases and deaths; to contrast the government's tally, we used the information collected by I-CBS covering 25 Special Indigenous Sanitary Districts (DSEI) in the Brazilian Amazon. The incidence and mortality rates of COVID-19 were calculated using the total number of new cases and deaths accumulated between the 9th and 40th epidemiological weeks. We studied (a) the availability of health care facilities to attend to Indigenous Peoples; (b) illegal mines, land grabbing, and deforestation to perform a geospatial analysis to assess how external threats affect Indigenous incidence and mortality rates. We used the Generalized Linear Model (GLM) with Poisson regression to show the results. Results: MOH registered 22,127 cases and 330 deaths, while COIAB's survey recorded 25,356 confirmed cases and 670 deaths, indicating an under-reporting of 14 and 103%, respectively. Likewise, the incidence and mortality rates were 136 and 110% higher among Indigenous when compared with the national average. In terms of mortality, the most critical DSEIs were Alto Rio Solimões, Cuiabá, Xavante, Vilhena and Kaiapó do Pará. The GLM model reveals a direct correlation between deforestation, land grabbing and mining, and the incidence of cases among the Indigenous. Conclusion: Through this investigation it was possible to verify that not only the incidence and mortality rates due to COVID-19 among Indigenous Peoples are higher than those observed in the general population, but also that the data presented by the federal government are underreported. Additionally, it was evident that the presence of illegal economic activities increased the risk of spreading COVID-19 in ILs

Meningococcal carriage within households in the African meningitis belt: A longitudinal pilot study.

OBJECTIVES: Carriers of Neisseria meningitidis are a key source of transmission. In the African meningitis belt, where risk of meningococcal disease is highest, a greater understanding of meningococcal carriage dynamics is needed. METHODS: We randomly selected an age-stratified sample of 400 residents from 116 households in Bamako, Mali, and collected pharyngeal swabs in May 2010. A month later, we enrolled all 202 residents of 20 of these households (6 with known carriers) and collected swabs monthly for 6 months prior to MenAfriVac vaccine introduction and returned 10 months later to collect swabs monthly for 3 months. We used standard bacteriological methods to identify N. meningitidis carriers and fit hidden Markov models to assess acquisition and clearance overall and by sex and age. RESULTS: During the cross-sectional study 5.0% of individuals (20/400) were carriers. During the longitudinal study, 73 carriage events were identified from 1422 swabs analyzed, and 16.3% of individuals (33/202) were identified as carriers at least once. The majority of isolates were non-groupable; no serogroup A carriers were identified. CONCLUSIONS: Our results suggest that the duration of carriage with any N. meningitidis averages 2.9 months and that males and children acquire and lose carriage more frequently in an urban setting in Mali. Our study informed the design of a larger study implemented in seven countries of the African meningitis belt